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Clinical Outcomes and Individualized Seed Implantation Planning for Iodine-125 Seeds Brachytherapy in Lymph Node
Dongcun Huang1, Zhihui Zhong1, Fujun Zhang1
1Department of Minimally Invasive Intervention, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.
Background:
Lymph node metastasis (LNM) critically influences cancer prognosis and treatment. This study explored the efficacy and prognostic factors of CT-guided radioactive iodine-125 (¹²⁵I) seed brachytherapy (RISB) for LNM and optimized the therapeutic dosage.
Methods:
We conducted a single-center retrospective cohort study analyzing 81 cases with histologically confirmed LNM (≤ 5 cm) from diverse primary cancers treated with CT-guided RISB. Postoperative dosimetric parameters (D90, D100, V90, V100, V150, V200) were assessed. Treatment response was evaluated at 6 months using RECIST 1.1, calculating the objective response rate (ORR) and local control rate (LCR). Patients were categorized into objective response and non-objective response groups based on treatment efficacy, and factors influencing treatment efficacy were identified through logistic regression analysis. Based on the ROC curve, the Youden index method was used to determine the dose optimization cutoff value.
Results:
The overall ORR was 71.6%, and LCR was 96.3%. The complication rate was 3.7%. Tumor size was an independent influencing factor for efficacy. Higher postoperative dosimetric parameters were associated with efficacy but were not independent influencing factors. ROC analysis identified the optimal D90 threshold as 102.7 Gy. The ORR in patients who achieved D90 > 102.7 Gy (n = 65, ORR = 81.54%) was significantly higher than in patients with D90 ≤ 102.7 Gy (n = 16, ORR = 31.25%) (p < 0.01). Complication rates did not differ between dose groups.
Conclusion:
Patients with LNM undergoing RISB can achieve a significantly higher ORR by ensuring a postoperative D90 > 102.7 Gy, without increasing the risk of complications. This dose threshold serves as a practical reference for clinical dose planning. Tumor size independently influences better response, guiding patient selection.
